title: Tracking intraoperative fluoroscopy utilization reduces radiation exposure during ureteroscopy.
abstract: OBJECTIVE
  Recent studies have demonstrated deleterious effects of ionizing radiation from diagnostic and therapeutic imaging procedures. One of the barriers to minimizing patient exposure is physician awareness. We prospectively studied whether providing surgeons with feedback on their fluoroscopy utilization would affect intraoperative fluoroscopy times.
  
  
  METHODS
  In 2007, we prospectively began to track fluoroscopy usage for all urology cases. Nine months later, surgeons started to receive periodic reports with their mean fluoroscopy time compared with their peers. We reviewed all ureteroscopic cases for nephrolithiasis from the date tracking began (2006-2010, n = 311). Using the initial 9-month period as a control, we studied the effect of providing feedback on mean fluoroscopy times in subsequent periods and analyzed patient factors that may affect radiation exposure.
  
  
  RESULTS
  Mean fluoroscopy times for unilateral ureteroscopy decreased by 24% after surgeons received feedback (2.74-2.08 minutes, p = 0.002). On multivariate analysis, factors that independently predicted decreased fluoroscopy times included female sex (p = 0.02), stones in the distal ureter (p = 0.04), and if the surgeon had received feedback (p = 0.0004). Factors that increased fluoroscopy times included the presence of hydronephrosis (p = 0.001), use of a ureteral access sheath (p = 0.04), ureteral balloon dilation (p = 0.0001), and placement of a postoperative stent (p = 0.002).
  
  
  CONCLUSIONS
  Providing surgeons with feedback on their fluoroscopy usage reduces patient and surgeon radiation exposure. Implementing such a tracking system requires minimal changes to existing operating room staff workflow. Further study is warranted to study the impact of this program on other procedures that utilize fluoroscopy in urology and other specialties.
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, California 94305, USA. tin.ngo@gmail.com
authors.forename: Tin C
authors.initials: TC
authors.lastname: Ngo
authors.forename: Liam C
authors.initials: LC
authors.lastname: Macleod
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rosenstein
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Reese
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shinghal
mesh_terms: D003710:Demography; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019990:Perioperative Care; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D013997:Time Factors; D018666:Ureteroscopy / Q000379:methods*